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Keeping Heart Failure from Worsening.

Individuals with heart failure are less likely to experience a worsening of their condition if they are treated with three drugs, including digoxin, an inexpensive medication in use for 200 years, suggests Kirkwood F. Adams, associate professor of medicine and radiology, University of North Carolina at Chapel Hill School of Medicine. He and colleagues argue that diuretics, ACE inhibitors, and digoxin should be used as soon as a patient is diagnosed as suffering from heart failure.

Adams, director of the university's heart failure program, says that digoxin has fallen out of favor among some doctors as a standard treatment for that condition because of concerns about toxicity. The combination of blood pressure agents known as diuretics (for reducing water retention) and ACE (angiotensin-converting enzyme) inhibitors, which dilate the blood vessels, are more widely advocated.

During controlled clinical trials, one investigation compared heart failure patients who were treated with both digoxin and diuretics to treatment with diuretics alone. The other compared patients who took diuretics and ACE inhibitors to those who received all three types of drugs.

The researchers found striking statistical differences in the risk of heart failure deterioration among four groups of men and women, average age 63. Over a 20-week study period, heart failure grew worse in 4.7% of patients who continued the triple drug therapy, compared to 19% of those on digoxin and diuretics, 25% of those taking ACE inhibitors and diuretic therapy, and 39% of those on diuretics alone. Digoxin was safe and well-tolerated among the study patients.

People on the triple drug therapy needed significantly fewer medication adjustments, emergency room visits, and hospitalizations. They also had greater exercise capacity, measured by the ability to walk an exercise treadmill, and showed a lack of deterioration in the heart's ability to pump blood.
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Publication:USA Today (Magazine)
Date:Feb 1, 1999
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